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Background: The high maternal and neonatal mortality rate in sub‐Saharan Africa could be reduced by using navigation by means of mobile devices to increase the number of women who choose to give birth in a health center (HC) with a skilled healthcare practitioner. Methods: A quasi‐experimental design was used to test a midwife‐delivered navigation by means of mobile phone. A total of 208 women were randomized to two groups (intervention and control). Women in the intervention group received up to three navigation calls from midwives. Women in the control group received usual antenatal education during prenatal visits. Data were collected using semistructured questionnaires. Childbirth location was determined through medical records. Results: Overall, 180 (87%) women gave birth in a HC with a 3% advantage for the intervention group. A total of 86% (88/102) of the control group gave birth in a HC versus 89% (92/103) for the intervention group (Χ2 = 0.44, p‐value = 0.51), with an unadjusted odds ratio of 1.33 (95% CI: 0.57, 3.09). Among those with personal phones, 91% (138/152) had a birth in a HC versus 79% (42/53) in those without a personal phone (Χ2 = 4.89, p‐value = 0.03). Conclusions: The results of this study indicate that it is feasible to deliver phone‐based navigation to support birth in a HC; personal phone ownership may be a factor in the success of this strategy. [ABSTRACT FROM AUTHOR]

Background: In order to evaluate interventions aimed at reducing cesarean births, care practitioners' attitudes are important to measure. The Labor Culture Survey (LCS) is a scale that measures individual and unit attitudes towards supporting vaginal birth. As no equivalent scale exists in Sweden, the aim was to translate, adapt, and validate the LCS and to investigate whether there were differences in attitudes toward supporting vaginal birth between maternity care practitioners. Methods: A cross‐sectional study including midwives, physicians, and nurse assistants working with intrapartum care in five labor wards in Sweden. The original LCS was translated into Swedish, and six context‐specific items were developed for the Swedish setting (SLCS). The translation was tested for face validity. Psychometric analysis was conducted using exploratory factor analysis with principal component analysis, parallel analysis, and principal axis factoring. Reliability was estimated using Cronbach's alpha. One‐way ANOVA and Tukey HSD were calculated to analyze differences in attitudes between professions on the subscales of the S‐LCS. Results: A total of 539 midwives, physicians, and nurse assistants participated. The final S‐LCS showed a five‐factor solution with the following subscales: Best Practices to reduce cesarean overuse, Unpredictability of vaginal birth, Unit Microculture, Maternal Agency, and Organizational Oversight. Chronbach alpha values varied from 0.60 to 0.83. Midwives were more supportive towards vaginal birth and less fearful of potential consequences of vaginal birth compared with physicians. Conclusions: The S‐LCS demonstrated satisfactory psychometric properties for use in Swedish maternity care. Further work to improve the scale should include additional items reflecting the subscale Maternal Agency. [ABSTRACT FROM AUTHOR]

Background: Collegial midwifery assistance during the active second stage of labor that involves a second midwife being present has been shown to reduce severe perineal trauma (SPT) by 30%. The aim of this study was to investigate primary midwives' experiences of collegial midwifery assistance with the purpose of preventing SPT during the active second stage of labor. Methods: This study uses an observational design with data from a multicenter randomized controlled trial (Oneplus). Data consist of clinical registration forms completed by the midwives after birth. Descriptive statistics as well as univariable and multivariable logistic regression were used to analyze the data. Results: The majority of the primary midwives felt confident (61%) and were positive (56%) toward the practice. Midwives with less than 2 years' work experience were more likely to completely agree they felt confident (aOR 9.18, 95% CI: 6.28–13.41) and experience the intervention as positive (aOR 4.04, 95% CI: 2.83–5.78) than those with over 20 years' work experience. Factors such as duration of time spent in the birthing room by the second midwife, opportunity for planning and if the second midwife provided support were further associated with the primary midwife's experience of the practice as being positive. Conclusions: Our findings indicate that having a second midwife present during the active second stage of labor was an accepted practice, with the majority of primary midwives feeling confident and positive toward the intervention. This was especially pronounced among midwives with less than 2 years' work experience. [ABSTRACT FROM AUTHOR]

Background: Research suggests that doula support improves birth outcomes, contributing to lower rates of preterm birth, low birthweight, and nonindicated cesarean delivery. Few studies investigate whether doula support is associated with the quality of patient‐reported birth experiences in hospital settings. Methods: This study uses data from Listening to Mothers in California, a statewide representative survey of women who gave birth in 2016 in Californian hospitals. The analytic sample included 1345 English‐speaking participants. We used multivariable logistic regression to test for associations between doula support and self‐reported unfair treatment, abuse, and rapport with delivery staff. We also examined associations between these experiences and openness to doula support in a future birth. Models adjusted for maternal sociodemographic characteristics and views about medical intervention in birth. Results: Just over 9% of women had doula support during birth. During their hospital stay, 6.3% reported unfair treatment, 11.5% reported abuse by providers, and 5.7% reported no rapport with delivery room staff. There were no statistically significant relationships between doula support and unfair treatment, abuse, or delivery staff rapport in our models. Participants who reported no rapport with hospital staff were more likely to express openness to doula support in a future birth (AOR: 2.59; 95% CI: 1.15, 5.79). Conclusions: Despite their best efforts, doulas may not be able to mitigate all negative interactions between their clients and hospital staff. These experiences may also influence desires for additional support from doulas in future births. Hospital policies and practices should include doulas as valuable members of the care team to help ensure positive experiences during birth. [ABSTRACT FROM AUTHOR]

Background: A positive childbirth experience is an important outcome of maternity care. A significant component of a positive birth experience is the ability to exercise autonomy in decision‐making. In this study, we explore women's reports of their autonomy during conversations about their care with maternity care practitioners during pregnancy and childbirth. Method: Data were obtained from a cross‐sectional survey of women living in The Netherlands that asked about their experiences during pregnancy and childbirth, including their role in conversations concerning decisions about their care. Results: A total of 3494 women were included in this study. Most women scored high on autonomy in decision‐making conversations. During the latter stage of pregnancy (32+ weeks) and in childbirth, women reported significantly lower levels of autonomy in their care conversations with obstetricians as compared with midwives. Linear regression analyses showed that women's perception of personal treatment increased women's reported autonomy in their conversations with both midwives and obstetricians. Almost half (49.1%) of the women who had at least one intervention during birth reported pressure to accept or submit to that intervention. This was indicated by 48.3% of women with induced labor, 47.3% who had an instrumental vaginal birth, 45.2% whose labor was augmented, and 41.9% of women who had a cesarean birth. Conclusions: In general, women's sense of autonomy in decision‐making conversations during prenatal care and birth is high, but there is room for improvement, and this appeared most notably in conversations with obstetricians. Women's sense of autonomy can be enhanced with personal treatment, including shared decision‐making and the avoidance of pressuring women to accept interventions. [ABSTRACT FROM AUTHOR]

Background: Bangladesh has experienced an alarming increase in birth through cesarean over the last decade. In this article, we examine rural Bangladeshi women's reporting of why they underwent cesarean, who proposed the cesarean, and when in the process, the decision for a surgical birth was made. Methods: We conducted a cross‐sectional household survey of 2299 women in Kushtia district. Of these, 1233 who gave birth through cesarean completed a supplemental questionnaire. Descriptive statistics were used to report cesarean rates, which were disaggregated by sociodemographic characteristics and by antenatal care contacts with health services. We analyzed women's reported reasons for having a cesarean, when the decision was taken, and who proposed the intervention. Findings: Over half (54%) of women gave birth through cesarean. The proportion of cesareans was significantly higher among women with higher educational attainment, higher socioeconomic status, and increased antenatal care during pregnancy, particularly if this care was sought in private facilities (P <.05). Women reported that health service providers primarily proposed the cesarean (73%), followed by family members (21%) and finally, the birthing person themselves (6%). With respect to the reasons for cesarean, 34% of women reported nonmedical reasons (convenience and avoidance of labor pain), and 44% mentioned only medical reasons. Over half of the women reported that the decision to undergo a cesarean was made on the day of birth. Conclusions: Women in rural Bangladesh often report avoidable reasons for cesarean. Better regulation of cesarean services in both public and private health services, as well as improved counseling of women with respect to cesarean indications and their consequences, is recommended. [ABSTRACT FROM AUTHOR]

Background: Concern with depression during the perinatal period has resulted in multiple states enacting legislation to require universal screening of mothers for postpartum depression. Despite this concern, rates of women receiving mental health counseling during pregnancy and postpartum remain low. This study examines factors, especially inequities in race/ethnicity, associated with receiving perinatal mental health counseling. Methods: This study draws on data from the Listening to Mothers in California survey of 2539 women, based on a representative sample of birth certificate files of women who gave birth in 2016. The survey included a series of mental health questions, based on the 4‐item Patient Health Questionnaire (PHQ‐4), and questions on the receipt of counseling, whether a practitioner asked respondents about their mental health, and whether the respondent was taking medications for anxiety or depression. Results: We found non‐Latina Black women to experience both higher rates of prenatal depressive symptoms and significantly lower use of postpartum counseling services and medications than non‐Latina White women. Among women with depressive symptoms, those asked by a practitioner about their mental health status reported a 46% rate of counseling compared with 20% who were not asked, and in a multivariable analysis, those asked were almost six times more likely (aOR 5.96; 95% CI 1.6‐21.7) to report counseling. Discussion: These findings lend evidence to those advocating for state laws requiring universal screening for depressive symptoms to reduce inequities and help address the underuse of counseling services among all women with depressive symptoms, particularly women of color. [ABSTRACT FROM AUTHOR]

Background: Registered midwives in British Columbia (BC) are primary health care practitioners for healthy people throughout pregnancy and for approximately 6 weeks postpartum. BC registered midwives are authorized to prescribe and administer certain vaccines to adults under their care during the perinatal period and hepatitis B vaccine to high‐risk newborns. However, little has been documented about their recommendations for, and administration of, prenatal and infant vaccinations. This study surveyed midwives currently practicing in British Columbia to understand their vaccination practices. Methods: An online survey was administered to the members of the Midwives Association of BC in spring 2018. Outcome measures were the proportion of midwives who discussed, recommended, and administered the following vaccines: influenza, varicella, rubella, and infant hepatitis B. The proportion of midwives who discussed and recommended infant vaccines was measured. Barriers to discussion, recommendation, and administration of vaccines were captured. Results: Sixty‐three percent of 108 respondents administered vaccines to their clients. Hepatitis B and rubella were the most frequent vaccines administered. Logistical concerns were the greatest barrier to vaccine administration. This was followed by the perception that vaccine administration is not within the scope of practice of midwives, especially for influenza vaccine. Midwives who administered vaccines were significantly more likely to discuss and recommend vaccines to their clients and their infants. Conclusions: The majority of BC midwives discuss, recommend, and administer vaccines to their clients. Our survey highlighted key areas to address to strengthen midwifery capacity to discuss, recommend, and provide prenatal and infant vaccines. [ABSTRACT FROM AUTHOR]

Background: In Hungary, 60% of women pay informally to secure continuity with a "chosen" provider for prenatal care and birth. It is unclear if paying informally influences quality of maternity care. This study examined associations between incentivized continuity care models and obstetric procedures and respectful care. Methods: This is a cross‐sectional survey of a representative sample of Hungarian women (N = 589) in 2014. We calculated descriptive statistics comparing experiences among women who paid informally for continuity with a chosen provider with those who received care in the public health system. After adjusting for social and clinical covariates, we used logistic regression to estimate the odds of obstetric procedures and disrespectful care and linear regression to estimate the level of autonomy (MADM scale). Results: Of women in our sample, 317 (53%) saw a chosen doctor, 68 (11%) a chosen midwife, and 204 (33%) had care in the public system. Women who paid an obstetrician informally had the highest rates of cesarean (49.5%), induction of labor (31.2%), and epidural (15%), and reported lower rates of disrespectful care (41%) compared to public care (64%). Paying for continuity with an obstetrician significantly predicted cesarean (aOR 1.61 [95%CI 1.00‐2.58]), episiotomy (2.64, [1.39‐5.03]), and epidural (3.15 [1.07‐9.34]), but not induction of labor (1.59 [0.99‐2.57]). Informal payment continuity models predicted increased autonomy scores (doctor: 3.97, 95% CI 2.39‐5.55; midwife: 7.37, 95% CI 5.36‐9.34) and reduced odds of disrespectful care. There were no differences in the prevalence of scheduled cesareans or inductions performed without a medical indication. Conclusions: Continuity models secured with informal payments significantly increased both women's experience of respectful care and rates of obstetric procedures. Intervention rates exceed global standards, and women do not choose elective procedures to preserve continuity. [ABSTRACT FROM AUTHOR]